Behavior Change Communication

Guest book review from Anita Makri, an editor and writer going freelance after 5+ years with SciDev.Net. (@anita_makri)

I’m sure that to readers of this blog the Ebola epidemic that devastated West Africa a couple of years ago needs no introduction (just in case, here’s a nice summary by the Guardian’s health editor). So I’ll cut to the chase, and to a narrative that at the time was bubbling underneath more familiar debates about responding to health crises – you know, things like imperfect governance, fragile health systems, drug shortages.

All of them important, but this narrative was new. It was about fear, communication and cooperation – the human and social side of the crisis (explored in a SciDev.Net collection I commissioned at the time). There was also an unsettling undercurrent to it – one that conveyed ‘otherness’ and ignorance on the part of West Africans, fuelled by reports of violence against health workers and of communities resisting expert advice against risky funeral rites.

But if you listened closely, you could just about make out the voices of anthropologists trying to dispel notions that these reactions were about exotic or traditional cultures. Paul Richards was one of those voices, and luckily he’s put together a rare account of evidence, theory and experience in a book that should trigger real reflection on how we can do better in handling similar crises (hint: more listening).

Ebola: How a People’s Science Helped End an Epidemic tells the story of the epidemic through the eyes of someone with intimate knowledge of the region and the rules that influence human interactions – very much an anthropologist’s perspective, not an epidemiologist’s. The book turns the mainstream discourse on its head, putting what Richards calls “people’s science” on an equal footing with the more orthodox science behind the international response. It captures how people and experts adapted to each other, falling into a process of knowledge co-production.

Richard H. Thaler is a world-renowned behavioral economist and professor of finance and psychology. Recently, he was interviewed by The Economist. The discussion covers some of the fundamental studies in the field, like “save more tomorrow” which encourages people to save more by signing up to increase their savings rate every year and auto-enrollment for pensions that have drastically increased employee participation in pension funds.

Thaler also suggests, in the interview, that behavioral economics has the ability to influence human behavior for both good and bad. He argues that much of what behavioral economics does is remove barriers. The goal is not to change people but to make life easier. However, that idea can be skewed by organizations or individuals looking to capitalize on the biases of people. Whenever he is asked to sign a copy of his book Nudge, he writes “nudge for good” which is a plea, he says, to improve the lives of people and avoid insidious behavior.

The list of ways companies nudge behavior is endless, and I would love to hear more examples from you all in the comments section. In the meantime here are a few- I’ll let you judge which ones “nudge for good”:

In an age when celebrity culture and corruption appear to be omnipresent, it’s quite refreshing to be reminded that there are good people doing good work day in and day out. These people work in our school systems, hospitals, charities, and as part of government bureaucracy. Yes, bureaucracy.

As Blair Glencorse states, “bureaucrats and civil servants can serve citizens in the way that they are supposed to.” With this in mind, the organization he founded, Accountability Lab, created Integrity Idol, a global campaign run by citizens in search for honest government officials. It aims to “highlight the good people in the system” as way to establish a culture and expectation of honesty and personal responsibility in government postings. Integrity Idol began in Nepal in 2014, spread to Liberia in 2015, and now includes Pakistan and Mali.

The process of selecting an Integrity Idol is participatory from beginning to end. Local teams of volunteers travel across their countries gathering nominations from citizens, hosting public forums and generating discussion on the need for public officials with integrity. From the long list nominees, five are selected in each country with the help of independent panels of experts. These finalists are then filmed and their episodes are shown on national television and played on the radio for a week, and citizens can vote for their favorites through SMS short-codes and on the website. The winner in each country is crowned in a national ceremony in the capital.

Here, Glencorse discusses Integrity Idol back in 2014, when the program was just getting started in Nepal. Nominations are now open in Pakistan, Nepal, and Mali. To nominate a candidate in one of these countries visit www.integrityidol.org.

Integrity Idol: How a reality TV show is changing minds about public service

The idea that there are untapped opportunities for improving the energy efficiency of individuals and homes is common. Energy efficient windows, lightbulbs, and appliances are sold worldwide. People are advised to “turn off the lights when you leave a room,” and schemes have been introduced to reduce energy consumption by tapping into social psychology. But what about large firms? Or entire industries? Companies, after all, want to minimize costs to save money, don’t they? How about airlines, whose bottom lines are subject to the international price of fuel?

It seems rational, but the International Energy Agency does not mention the aviation sector in its Energy Efficiency Market Report, nor does Kinsey in their comprehensive catalog of potential energy efficiency measures. Most reports (that I could find) focus on regulation of commercial enterprises. This is a shame. The environmental impact of aviation is clear: aircraft engines emit heat, noise, particulates, CO2, and other harmful gases that contribute to climate change. Despite more fuel-efficient and less polluting turbofan and turboprop engines for airplanes as well as innovations in air frames, engines, aerodynamics, and flight operations, the rapid growth of air travel in recent years has contributed to an increase in total aviation pollution. In part, this is because aviation emissions are not subject international regulation thus far and because the lack of global taxes on aviation fuel results in lower fares than one would see otherwise.

Interestingly, although perhaps not surprisingly, the National Bureau of Economic Research just released a working paper that suggests airlines’ fuel consumption can be reduced if they “nudge” the pilots to use less fuel, using behavioral interventions.

Globally, 157 cities around the world now have a metro system in operation. These underground trains shuttle people back and forth from work, make weekend escapes possible, and allow tourists to get around without the hassle of human communication.

The sheer number of people using metro systems has inspired quite a few rules of etiquette. In Japan it’s considered polite to switch your phone to “Manner Mode” (also known as “silent” mode) when using the metro so that other passengers aren’t subjected to ringtones as they travel. Eating durian, considered the world’s smelliest fruit, is not permitted on Singapore’s MRT, and “No durian” signs have been posted around the network. It’s also considered bad manners to sit in priority seats in Seoul subway cars at any time, regardless of whether there’s anyone around who needs them.

But perhaps the stickiest, most sincerely held rule of etiquette is that when using an escalator to enter or exit a metro station, one should stand on the right and walk on the left. This way, those who want to climb the stairs can do so on the left, without having the say “excuse me” every 5 seconds. This rule is especially important to follow at rush hour if you want to avoid grumpy remarks. Those who have forgotten to follow it can probably speak to how sanctimonious some people feel about it.

On that particular Friday, 11,000 passengers got off at Holborn Station between 8.30 and 9.30am and faced an unusually upsetting provocation. As they turned into the concourse and looked up to the station’s escalators, they saw something truly horrifying: dozens of people were standing on the left.

It is now the second week of 2016 and many people are working (or struggling) to follow through on their New Year’s resolutions. Whether they have decided to run a marathon, travel more, or save money, many people endeavor to create positive, new habits while shedding existing habits they think are less positive. These resolutions, though, tend to last one or two months, fading into the backgrounds of their consciousness as spring arrives.

It’s a typical combination of the planning fallacy, unrealistic optimism, and a bit of self-regulatory failure.

And this sort of challenge is not specific to New Year’s resolutions or even to issues pertaining to individuals. City councils frequently draw up budgets that are too lean, road construction frequently lasts much longer than expected, and advances in technology often require much more investment than planners expect. So what’s at work here? Why is it that people have a hard time judging the amount of time, energy, and resources that a project will take?

Our Top Ten blog posts by readership in 2015.This post wasoriginally posted on April 7, 2015.

In an appeal to civic duty, the Government of India is asking citizens to forgo a gas subsidy they receive so that gas cylinders can be transferred to the less fortunate. To encourage Indians to "Give It Up," the government called on business leaders to set an example and made the procedure extremely easy.

India recently launched an ambitious cash transfer program to help small businesses and households buy fuel. Under the plan, consumers of liquefied petroleum gas (LPG), commonly referred to as propane or butane, receive a cash subsidy in their bank accounts to buy gas cylinders at market price.

Once joining the scheme, the subsidy, which is equal to the difference between the current subsidized rate and the market price, is transferred to the consumer’s bank account when he/she orders a cylinder. Another transfer is then provided at the time of delivery of the cylinder.

Last November, the Direct Benefit Transfer Scheme for LPG was rolled out across 54 districts, with the rest of the country participating by January 1 of this year.

The scheme was launched by India’s previous UPA government in June 2013, but it was abruptly stopped earlier this year following court orders. It has since been modified to exclude the requirement of providing a unique identification number (Aadhaar) to avail the cash subsidy.

The idea behind the direct benefit transfer is that it can ensure that the subsidy meant for the genuine domestic customer reaches them directly and is not diverted. The Government of India hoped to save millions each year by curbing diversions and leakages in the system but also to ensure efficient delivery of subsidies to the target beneficiaries— the consumers.

Mobile phones are increasingly prevalent throughout the world, and researchers have found that sending text message reminders can help people follow-through with their intentions, significantly increasing the success of development interventions.

“People need to be reminded more often than they need to be instructed.”

These are the wise words of Samuel Johnson, an English author, critic, and lexicographer. Even though he lived more than 200 years ago, international development interventions are proving him correct today.

Reminders for Malaria

It’s widely known that failure to adhere to a full course of antibiotic treatment leads to treatment failure and encourages bacterial resistance to antibiotics, threatening the sustainability of current medications. This is extremely important for malaria, which, according to the World Health Organization, results in 198 million cases each year and around 584,000 deaths. The burden is particularly heavy in Africa, where around 90% of malaria deaths occur, and in children under 5 years of age, who account for 78% of all deaths. Moreover, low rates of adherence to artemisinin-based combination therapy (ACT) treatments has led to a prevalence of antibiotic-resistant Malaria in many parts of the world, particularly Africa. One of the biggest – and simplest – reasons why people fail to complete the full treatment for Malaria is that they forget.

Following prolonged conflict, it is often difficult to reestablish security and reduce crime and violence, especially among poor young men. In Liberia, development experts have been researching the most effective ways to support high-risk individuals, and they may have found an effective approach combining therapy with cash.

One of the most pressing concerns in post-conflict settings is how to help individuals transition back into a peaceful life. After a conflict has subsided, small arms are usually very common, local and national economies have been destroyed, and the emotional stress of the violence begins to take on new forms. Former soldiers, in particular, have trouble with the transition as they struggle with the pain and horror of what they experienced, and many do not remember how to participate in community life anymore. In response, the international development community often tries to “enable” these men by creating jobs for them. The theory is that if people are busy working they will not have the time or the inclination to commit crime.

However, simply providing jobs is rarely enough. The Network for Empowerment & Progressive Initiative (NEPI), an organization operating in Monrovia, Liberia, challenges this paradigm and seeks to support men formerly engaged in the country’s two civil wars by rehabilitating them through therapy.

Klubosumo Johnson Borh, the founder of NEPI, was as a Liberian teenager when he was recruited for Charles Taylor‘s infamously brutal rebel army. Borh was made a commander and oversaw soldiers who were even younger than he was. By the end of the conflict, which lasted from 1989 through 2003, nearly 10% of the population had been killed, and thousands of child soldiers were now grown men. Many of these men had trouble shaking the violent behaviors they had learned in war so Borh helped start NEPI in an effort to reform these and other troubled men.

In order to tackle the adverse effects of climate change in our lifetimes, the global community will need all hands on deck. One software company has found a way of reducing energy consumption by tapping into social psychology.

One way of thinking about how to approach climate change is to divide the issue into ‘wedges’. One wedge would be to increase renewable energy production, another would be to increase energy efficiency in the electric grid, and a third, to make buildings more energy efficient. Along with these other improvements, changing human behavior is another, very important wedge.

Two families that are demographically similar, living side by side, in similar apartments, can use dramatically different amounts of energy— the difference of which can be attributed to behavioral differences.

Keeping up with the Neighbors

These behavioral differences were demonstrated in a famous psychology experiment that focused on home energy use. The research team, led by two psychologists, Robert Cialdini of Arizona State University and Wesley Schultz of California State University, San Marcos, hung a series of five door hangers with energy-saving messages on several hundred homes in a San Diego suburb in 2004. One hanger encouraged people to "join their neighbors" in conserving energy, one appealed to their self-interest to save money, another called on them to save energy to protect the environment, and a fourth asked them to conserve energy for future generations and the benefit of society. A fifth and final message simply stated that summer is here and it’s a time to save energy with no underlying reason.

The researchers measured the effectiveness of the messages by obtaining meter readings before and after the door hangers were distributed. They found that the last four had minimal effect. But the first, which mentioned the neighbors, produced a significant 10% reduction in home energy usage.